Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994523 DEA: 041K3004 EFIS: 0416000226 COOP: 042856
QA Service Level: 2
DIST-CO-RTE-PM: 04-SCL-280-7.1/9.5
Work Description: Improve Traffic Operations, Wolfe Road
Location Description: SCL 280/Wolfe Rd. Interchange
Contractor Name: BRIDGEWAY CIVIL CONSTRUCTORS, INC.
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: Kumar Lakshmanan Structure Rep.: Hoc Doan
DIME Sample ID: 2026-09-29-5
TL Number from the TL Form:
Sample Submitted By Organization: Con-Fab California Corporation - Lathrop
Sample Organization Contact: (209) 249-4700
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 09/29/2026
Date that the sample was received by the laboratory/organization performing the testing: 09/23/2026
The quantity of what the sample constitutes: 1 cubic ft. of Concrete for Testing
A brief description of the sample: Bed 7, Middle of Truck 5
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Con-Fab California, LLC - Lathrop
The concrete mix design number: L_98M1L
The truck number from where the sample was collected:
The batch plant ticket number from where the sample was collected: 15276
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: Bed 7, Middle of Truck 5
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
DIME Test ID: 2026-09-29-5-2
Test Method: ASTM C1611-21: Standard Test Method for Slump Flow of Self-Consolidating Concrete
Verified Date: 10/08/2026
Date Tested: 09/29/2026
Submitted By Organization: Con-Fab California Corporation - Lathrop
Organization Address: 1910 Lathrop Road,
Organization City: Lathrop
Organization State: CA
Organization Zipcode: 95330
Organization Email: jerryx@confabca.com
Organization Phone: (408) 466-5557
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
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What unit system is used for measurements?
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inches
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Slump Flow
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26 in
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Filling the mold procedure
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Filling Procedure B (Inverted Mold)
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Diameter 1
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26 in
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Diameter 2
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26 in
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Visual Stability Index
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no data0
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